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. 2019 Nov 20;19(1):69.
doi: 10.1186/s12873-019-0288-4.

Effectiveness of interventions to alleviate emergency department crowding by older adults: a systematic review

Gijs Hesselink  1   2 , Özcan Sir  3 , Yvonne Schoon  3   4
Affiliations

Effectiveness of interventions to alleviate emergency department crowding by older adults: a systematic review

Gijs Hesselink et al. BMC Emerg Med. .

Abstract

Background: The growing demand for elderly care often exceeds the ability of emergency department (ED) services to provide quality of care within reasonable time. The purpose of this systematic review is to assess the effectiveness of interventions on reducing ED crowding by older patients, and to identify core characteristics shared by successful interventions.

Methods: Six major biomedical databases were searched for (quasi)experimental studies published between January 1990 and March 2017 and assessing the effect of interventions for older patients on ED crowding related outcomes. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data into a standardized form. Data were synthesized around the study setting, design, quality, intervention content, type of outcome and observed effects.

Results: Of the 16 included studies, eight (50%) were randomized controlled trials (RCTs), two (13%) were non-RCTs and six (34%) were controlled before-after (CBA) studies. Thirteen studies (81%) evaluated effects on ED revisits and four studies (25%) evaluated effects on ED throughput time. Thirteen studies (81%) described multicomponent interventions. The rapid assessment and streaming of care for older adults based on time-efficiency goals by dedicated staff in a specific ED unit lead to a statistically significant decrease of ED length of stay (LOS). An ED-based consultant geriatrician showed significant time reduction between patient admission and geriatric review compared to an in-reaching geriatrician.

Conclusion: Inter-study heterogeneity and poor methodological quality hinder drawing firm conclusions on the intervention's effectiveness in reducing ED crowding by older adults. More evidence-based research is needed using uniform and valid effect measures.

Trial registration: The protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017075575).

Keywords: Emergency department crowding; Older adults; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study selection and review process
Fig. 2
Fig. 2
Reviewers' judgments about each risk of bias item presented as percentages across all included studies; legend: Green (low risk of bias); Yellow (unclear risk of bias); Red (high risk of bias)
See this image and copyright information in PMC

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